Cultural orientation and safety app for new and short-term health care providers in Nunavut.

SETTING: One of the greatest challenges of Nunavut's health care system is its reliance on short-term professionals, many of whom are not oriented to the Inuit historical/cultural context and the organization of health care in the territory. Our objective was to develop a free iOS/Android app to address this knowledge gap. INTERVENTION: We reviewed existing literature and interviewed key stakeholders to develop the content of the app covering the following: Inuit ways of communicating and expectations in the health care setting; Inuit history, settlement, and societal values (including a bibliography and a list of Inuktitut language phrases and resources); health care model (including referral pathways for tertiary care and mental health referrals); maps and community information; and useful information to prepare for your arrival. The app, HealthNU, was launched in September 2017. We targeted new and short-term health care providers in Nunavut, and the app has also been circulated and used by social workers, educators, and health care providers outside of the territory. OUTCOMES: By September 5, 2019, the app had been downloaded more than 700 times. To evaluate the app, we conducted interviews and a brief survey with key stakeholders (n = 18), who indicated that (1) the app was easy to use; (2) the content was highly relevant and would result in improved cultural competencies; and (3) they would recommend the app to colleagues and were already using it for recruitment/orientation. Challenges and limitations included: ensuring practitioners "completed" all modules while reading/using the app, and low response rate among providers who were solicited for feedback. IMPLICATIONS: HealthNU is an example of how technology solutions developed in partnership with community members, health care providers, researchers, and government can improve the quality of care for Nunavummiut. We are currently working with the Nunavut Department of Health to develop similar apps in other contexts.

Patient transportation in Canada's northern territories: patterns, costs and providers' perspectives.

INTRODUCTION: Canada's northern territories are characterized by small, scattered populations separated by long distances. A major challenge to healthcare delivery is the reliance on costly patient transportation, especially emergency air evacuations (medevacs). The purpose of this study was to describe the patterns, costs and providers' perspectives on patient transportation, and identify potential factors associated with utilization and performance. METHODS: Secondary analyses of medical travel databases and an online survey of nurses in the communities and physicians in regional centers were undertaken. RESULTS: The proportion of the population living within 100 km of a hospital was 83% in Yukon, 63% in Northwest Territories (NWT) and 21% in Nunavut. In Nunavut and NWT, road access to a hospital was limited to residents of the cities where the hospitals were located, with the rest relying exclusively on air travel. Medevac rates varied among the three territories: 0.9 trips/1000 residents/year in Yukon, 32/1000 in NWT and 53/1000 in Nunavut. In Yukon, all communities except one are road-accessible whereas in Nunavut no communities are connected by roads. The relative absence of roads is a major reason why the patient transportation costs are high in Nunavut and NWT. The rate of medevacs originating from the remote, air-accessible-only communities varied greatly, which cannot be explained by the air distance from the nearest hospital, population size or frequency of health center visits. Medical travel accounts for 5% of the health expenditures in NWT and 20% in Nunavut. A medevac on average costs $218 per person per year in NWT and $700 in Nunavut. The providers survey detected only 66% or less in support of statements that nurses in the communities received timely access to clinical advice, whereas only 50% of physicians agreed with statements that the clinical information provided by the nurses was clear. CONCLUSION: Patient transportation, especially emergency air evacuations, is an essential but costly component of the healthcare system serving Canada's north. It is the 'glue' that binds an extensive network of facilities staffed by different categories of health professionals. While system design is largely dictated by geography, addressing human factors such as interprofessional communication is important for improving the system's effectiveness. This study is primarily descriptive and it points to additional areas for improved understanding of the performance of the system.

What role can unmanned aerial vehicles play in emergency response in the Arctic: A case study from Canada.

This paper examines search and rescue and backcountry medical response constraints in the Canadian Arctic and potential for unmanned aerial vehicles (UAV) to aid in response and preparedness. Semi-structured interviews (n = 18) were conducted with search and rescue responders, Elders, and emergency management officials to collect data on current emergency response and potential for UAV use. UAV test flights (n = 17) were undertaken with community members. We analyzed five years of weather data to examine UAV flight suitability. Numerous challenges face Arctic search and rescue and backcountry emergency response. Changing social and environmental conditions were described as increasing vulnerability to backcountry emergencies. Responders desired additional first aid and emergency training. Legal and weather restrictions were found to limit where, when and who could fly UAVs. UAVs were demonstrated to have potential benefits for hazard monitoring but not for SAR or medical response due to legal restrictions, weather margins, and local capacity. We find that communities are ill-prepared for ongoing SAR demands, let alone a larger disaster. There are numerous limitations to the use of consumer UAVs by Arctic communities. Prevention of backcountry medical emergencies, building resilience to disasters, and first responder training should be prioritized over introducing UAVs to the response system.

Backcountry Travel Emergencies in Arctic Canada: A Pilot Study in Public Health Surveillance.

Residents in the Canadian Arctic regularly travel in remote, backcountry areas. This can pose risks for injuries and death, and create challenges for emergency responders and health systems. We aimed to describe the extent and characteristics of media-reported backcountry travel emergencies in two Northern Canadian territories (Nunavut and Northwest Territories). A case-series of all known incidents between 2004 and 2013 was established by identifying events in an online search of two media outlets, Nunatsiaq News and Northern News Services. We identified 121 incidents; these most commonly involved young men, and death occurred in just over 25% of cases. The territories differed in the seasonal patterns. News media provides a partial source of data to estimate the extent and characteristics of backcountry emergencies. This information is needed to improve emergency preparedness and health system responsiveness in the Arctic.

Calcium efflux activity of plasma membrane Ca2+ ATPase-4 (PMCA4) mediates cell cycle progression in vascular smooth muscle cells.

We explored the role played by plasma membrane calcium ATPase-4 (PMCA4) and its alternative splice variants in the cell cycle of vascular smooth muscle cells (VSMC). A novel variant (PMCA4e) was discovered. Quantitative real-time-PCR-quantified PMCA4 splice variant proportions differed in specific organs. The PMCA4a:4b ratio in uninjured carotid arteries (∼1:1) was significantly reduced by wire denudation injury (to ∼1:3) by modulation of alternative splicing, as confirmed by novel antibodies against PMCA4a/e and PMCA4b. Laser capture microdissection localized this shift to the media and adventitia. Primary carotid VSMC from PMCA4 knock-out (P4KO) mice showed impaired [(3)H]thymidine incorporation and G1 phase arrest as compared with wild type (P4WT). Electroporation of expression constructs encoding PMCA4a, PMCA4b, and a PMCA4b mutant lacking PDZ binding rescued this phenotype of P4KO cells, whereas a mutant with only 10% of normal Ca(2+) efflux activity could not. Microarray of early G1-synchronized VSMC showed 39-fold higher Rgs16 (NFAT (nuclear factor of activated T-cells) target; MAPK inhibitor) and 69-fold higher Decorin (G1 arrest marker) expression in P4KO versus P4WT. Validation by Western blot also revealed decreased levels of Cyclin D1 and NFATc3 in P4KO. Microarrays of P4KO VSMC rescued by PMCA4a or PMCA4b expression showed reversal of perturbed Rgs16, Decorin, and NFATc3 expression levels. However, PMCA4a rescue caused a 44-fold reduction in AP-2ß, a known anti-proliferative transcription factor, whereas PMCA4b rescue resulted in a 50-fold reduction in p15 (Cyclin D1/Cdk4 inhibitor). We conclude that Ca(2+) efflux activity of PMCA4 underlies G1 progression in VSMC and that PMCA4a and PMCA4b differentially regulate specific downstream mediators.